Balkan endemic nephropathy (BEN) is a serious kidney disease that occurs only in clusters of rural villages located in tributary valleys of the Danube River in the Balkan Peninsula. It is believed that at least 25,000 persons are suffering from BEN or are suspected of having the disease and that the total number of people at risk may exceed 100,000. BEN was first described as a distinct medical entity in 1956, but it may have existed undescribed for many centuries. The geographic distribution of the disease has not changed significantly since the 1950's. Villages afflicted in the past continue to have cases of BEN, while villages with no history of BEN (some of which are only a few miles from affected villages) have remained free of this disease.

Work by the U.S. Geological Survey and others in the early 1990's noted the close correspondence between the location of the affected villages and the occurrence of coal deposits, specifically
lignites deposited in the Pliocene Epoch 5.3 million to 1.6 million years ago.

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